# Mikulicz’s disease combined with IgG4-related hypophysitis: a case report

## TL;DR

A 77-year-old woman with Mikulicz’s disease and IgG4-related hypophysitis showed improvement with prednisolone treatment.

## Contribution

This case report highlights the rare combination of Mikulicz’s disease and IgG4-related hypophysitis in an elderly woman.

## Key findings

- The patient had elevated serum IgG4, thickened pituitary stalk, and masses in the jaw and orbit.
- Treatment with prednisolone reduced symptoms and mass size.
- The case suggests IgG4-RD can cause head and neck masses and pituitary stalk thickening in the elderly.

## Abstract

IgG4-related diseases are very uncommon, and its diagnosis and treatment are complicated as it encompasses multiple disciplines.

: A 77-year-old woman was admitted with a jaw mass and nausea and vomiting. Laboratory tests showed elevated serum IgG4, pituitary MRI suggested thickening of the pituitary stalk, and head and neck CT suggested orbital and mandibular masses. Patients with mandibular mass were diagnosed with Mikulicz’s disease with IgG4-related hypophysitis. We found no other evidence of causing thickening of the pituitary stalk. She was given oral prednisolone 30 mg daily, and her nausea and vomiting improved significantly, and the mandibular and ocular masses decreased in size.

Mikulicz’s disease combined with IgG4-related hypophysitis is a rare case of IgG4-RD in elderly women. IgG4-RD is one of the causes of head and neck exocrine gland mass and pituitary stalk thickening in the elderly.